Sonuç olarak PH‟da hastalık süresi ve özürlülük derecesindeki artıĢ ile paralel olarak belirgin kötüleĢme gösteren uyku bozuklukları ve gün içinde sık uyuklamalar görülmektedir. Bu bozuklukların tanısı hasta ve hasta yakınının ayrıntılı sorgulanması ile mümkün olabilmektedir. Hastalığın genel değerlendirmesi ve tedaviye yaklaĢımda uyku bozukluğu önemli bir parametre olabilir.
Depresyon varlığı tanısal karıĢıklıklar yaratmakta, hastalık Ģiddetini olumsuz etkileyerek tedaviyi güçleĢtirmektedir. Bu nedenlerden ötürü Parkinson hastalarında depresyon, hekimler tarafından aktif olarak sorgulanması ve saptandığında mutlaka tedavi edilmesi gereken bir ruhsal sorundur. Böylece, zaten Parkinson belirtileri nedeniyle bozulmuĢ olan yaĢam kalitesinin daha fazla olumsuz etkilenmesi engellenebilir.
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48 8. EKLER
8.1. Hoehn-Yahr Sklası
Hoehn ve Yahr tarafından 1967 yılında kullanıma sunulmuĢtur. PH‟nin evresini belirlemede en sık kullanılan ölçektir (136). Hastalık, parkinsonizm bulgularının dağılım ve Ģiddetine göre 5 ayrı evrede değerlendirilir.
Evre 1. PH‟nin baĢlıca özellikleri olan tremor, rijidite ya da bradikinezinin unilateral olması
Evre 2. Yukarıda adı geçen özelliklerin bilateral olması ve muhtemelen konuĢma anormallikleri, postürde bozulma ve yürüme anormalliğinin olması ancak dengenin korunmuĢ olması.
Evre 3. PH‟nin bilateral özelliklerinin kötüleĢmesi yanı sıra denge bozukluğu vardır. Hasta hala tek baĢına iĢlevlerini yerine getirebilir.
Evre 4. Hastalık ciddi Ģekilde ilerlemiĢtir. Hasta aykta durabilir ancak iĢlevleri için yardıma muhtaçtır.
Evre 5. Hasta tekerlekli iskemle kullanmak zorundadır veya yatağa bağımlıdır.
8.2. Hamilton Depresyon Derecelendirme Ölçeği (HAM-D):
Hastalardaki depresyonun Ģiddetini ölçmek için kullanılan, değerlendiricinin derecelemesine dayanan, 17 soruluk bir ölçektir. 1960 yılında Max Hamilton tarafından yayınlanmıĢtır. Depresyonun derecesini ölçmek için en yaygın olarak kullanılan yöntemdir. Ölçeğin uykuya dalma güçlüğü, gece yarısı uyanma, sabah erken uyanma, somatik semptomlar, genital semptomlar, zayıflama ve iç görü ile ilgili maddeleri 0-2, diğer maddeleri 0-4 arasında derecelendirilmiĢtir. Her maddedeki belirtinin hastada bulunup bulunmadığının ve “hafif”, “orta”, “ağır” gibi Ģiddet derecesinin, o madde için var olan soruların yöneltilmesi ve yanıtlarının esas alınmasıyla uzman tarafından belirlenmesi suretiyle kullanılmaktadır. Yapılan derecelendirmenin toplanmasıyla 0 ile 53 arasında değiĢen ölçek toplan puanı elde
49 edilmektedir ve puandaki artıĢ depresyonun Ģiddetindeki artıĢa iĢaret etmektedir. 0-7 puan depresyon olmadığını, 8-15 puan arası hafif derecede depresyonu, 16-28 arası orta derecede depresyonu, 29 ve üzeri ağır derecede depresyonu göstermektedir. Türkiye için geçerlilik, güvenirlilik çalıĢması Akdemir ve ark. (1996) tarafından yapılmıĢtır (132).
8.3. Parkinson Hastalığı Uyku Ölçeği (PHUÖ) :
2001 yılında Chaudhuri ve ark. tarafından oluĢturulan Parkinson Hastalığı Uyku Ölçeği (PHUÖ) kullanılmaya baĢlanmıĢtır. Bu ölçek hastanın son haftayı göz önüne alarak yanıtlayacağı 15 sorudan oluĢmaktadır. Bununla gece boyunca uykunun bir bütün olarak kalitesi (soru 1), uykuya baĢlama ve devam ettirebilme zorluğu (soru 2-3), gece HBS benzeri huzursuzluk verici semptomların varlığı (soru 4-5), noktürnal psikoz (soru 6-7), noktüri (soru 8-9), noktürnal motor semptomlar (soru 10-13), uykunun dinlendiriciliği (soru 14) ve gün içindeki uyuklamalar (soru 15) değerlendirilebilmektedir. Test her bir soru için 0 (Ģikayetlerin çok Ģiddetli olması) ile 10 (Ģikayet olmaması) arasında puan verilerek yapılır. Toplam puan 150‟dir (uyku ile ilgili hiçbir Ģikayetin olmaması) (133).
8.4. Epworth Uykululuk Ölçeği (EUÖ):
Gün içindeki aĢırı uyku hali ve ani uyuklamaların değerlendirilmesinde ise Epworth Uykululuk Ölçeği (EUÖ) yaygın olarak kullanılmaktadır. Her birinin 0 ile 3 arasında bir puan verilerek değerlendirildiği 8 sorudan oluĢmaktadır. Toplam 10 veya daha fazla puan, artmıĢ gündüz uykululuk halini ve 15 üzerindeki puanlar da patolojik uykululuk halinin varlığını düĢündürmektedir (134).